Treatment guidelines for elderly patients with NSCLC – an update

In this analysis, the European Organization for Research and Treatment of Cancer (EORTC) and the International Society of Geriatric Oncology (SIOG) updated recommendations for treating elderly patients with non-small-cell lung cancer (NSCLC).

The average age of patients diagnosed with NSCLC is 71 years old. This is increasing due to the aging population of the western world. In 2010, the EORTC and the SIOG gathered a panel of experts who provided recommendations for the treatment of elderly patients with NSCLC. In 2013, they performed a large scale meta-analysis (review of data from multiple studies) to update these recommendations.

The meta-analysis involved reviewing current and past literature on treatments for patients with NSCLC above the age of 70. The panel of experts made several updates to the original recommendations.

For patients with early stage disease, surgery should be considered despite patient age. However, less invasive procedures, such as video-assisted thoracoscopic surgery (where a camera and tools are inserted through small cuts in the skin) are preferred when possible. For patients who cannot undergo surgery, stereotactic ablative body radiation therapy can be considered. This is a type of radiation therapy which focuses on the tumor and limits radiation to surrounding organs. Radiation therapy led to similar 1-year survival rates (87%) compared to surgery (75%).

Chemotherapy (chemotherapy combined with either surgery or radiation) can also benefit survival, though this has not been well studied in patients over the age of 80.

In patients with locally advanced disease (cancer that has spread near to the place it started), radiation therapy combined with chemotherapy or surgery can be used in fit patients. However, few studies were found addressing this population. Treatment decisions should take the patients age, fitness level, and life expectancy into account.

In patients with advanced metastatic disease (cancer that has spread to other parts of the body), chemotherapy should be considered. Two chemotherapy agents can be used in fitter patients. One trial found that a carboplatin (Paraplatin) and paclitaxel (Abraxane) combination improved survival by 4.1 months compared to treatment with a single chemotherapy. However, single agents may be used in patients that are less fit.

For patients with specific genetic mutations (genetic change causing cancer growth), targeted therapy should be considered. Second-line treatment (treatments offered after failure of a first) should also be considered despite patient age.

These recommendations concluded that treating elderly patients with NSCLC should not be based on age alone. Comprehensive geriatric assessment (CGA, an evaluation of the overall health and status of elderly patients) should be considered when deciding what treatment to use.